Lessons in saving lives

After more than 20 years of volunteering with the Red Cross in some of the most difficult conflict zones around the world, British surgeon David Nott is now hoping to inspire other doctors to follow suit.

Through the Nott Surgical Foundation in the UK, he will pass on the knowledge he’s accumulated over the years by teaching and training doctors to go into conflict or catastrophe-stricken areas.

Small teams of doctors can then “train the local people how to do the operating, how to save people’s lives,” said Nott in an interview on a recent visit to Dubai. “They would stay there for a week or two, training people and then they will come back.”

Over two decades, Nott has volunteered in places including Gaza, Syria, Afghanistan, Sierra Leone, Chad and many others. He felt the need to establish the foundation after witnessing the challenges doctors face in war-torn locations.

His foundation will not only focus on war zones, but also on countries where the medical infrastructure has degraded due to previous conflicts, including in a number of African countries.

“Training doctors throughout the world in various places is not very good and most doctors if there’s a conflict zone will leave. There will be some doctors that won’t leave, but you don’t know what kind of training they’ve got. "So it’s a matter of going in to try and help those people to increase their knowledge and expertise on how to do things,” said Nott.

Nott was in the Gaza Strip for the duration of the recent 50-day Israeli offensive that claimed more than 2,000 Palestinian lives, mostly civilian, and displaced almost half a million others. The Gaza Strip, one of the most densely populated areas on earth, has been under an Israeli land, air and sea blockade since 2007.

Nott works with a number of organisations, including the International Committee of the Red Cross (ICRC) and Medicines Sans Frontiers. While in Gaza, he worked at various hospitals such as Al Shifa, Al Quds and Al Aqsa, dealing with explosive injuries to adults and children.

Remembering the situation there at the time, Nott said the bombardment of the city was constant, continuing day and night. “One night we had 700 shells coming from the sea, 400 tank shells, 15 F-15 drop bombs. It was very intense. Everything was shaking, the ground, the houses, we were in a bunker that was shaking, and the noise was just phenomenal,” he said. “If you’re firing missiles they are not very accurate so we all felt there was a possibility of us being killed.”

As bombardment increased and the situation deteriorated, the United Nations sent home two thirds of their contingent and the Red Cross was in the process of sending home two thirds of theirs to put people out of harms way, recalled Nott. Engrained in his memory is one particular night at Al Shifa hospital when they received a message from ICRC saying the premises would be bombed in five minutes and everyone had to evacuate.

“But I was operating on a child and I couldn’t leave the child on the operating table. As a surgeon you can’t leave your patients, you have to stay,” Nott recalled the harrowing moments. “You just have to hope it doesn’t happen… But you can’t leave somebody to die on an operating table. She was seven and in a very bad way. I couldn’t leave her and just run away and come back so I just stood there and hoped nothing would happen.” The hospital was spared that night and the little girl’s life was saved.

Many others, however, didn’t make it. The most difficult moments Nott faced included seeing the number of dead people brought in, and the difficulty of delivering their bodies to their families due to constant shelling.

“I think that was the most difficult part of it, seeing so many dead people. Because there’s nothing obviously you can do to them, but it’s just the sadness of man’s inhumanity to man,” he said.

Despite the immense suffering that Nott witnessed in Gaza, he was able to conclude that chapter on a bright note. Just before departing, he was contacted by the Palestine Children’s Relief Fund to help a baby girl – Hala Al Masri – who had a hole in her heart and required an urgent operation. Hala’s home was blown up and she was taking shelter with her mother at a UN school in Gaza.

“I took the baby back with me on a plane to London with her mother. She almost died en route but she had her heart operation and then went back to Gaza a few weeks ago, so it was a very nice way to end the mission,” Nott said.

Today in Gaza, there are “terrible wounds (that) need to be dealt with, lots of post conflict surgeries, managing people’s amputations and wounds, constant problems that they are having maybe with their abdominal discharges,” a need for many hospital beds to be created and homes to be rebuilt for people to go back to, said Nott. But “it’s an ongoing problem, a vicious cycle that seems to happen every two to three years. A political solution needs to be discussed.”

To Arab states, Nott’s message is to work out a strategy “to help poor civilian people that are taking the brunt of everything. It’s not the fighters… but the population, and the Arab world needs to wake up to the fact that this is going on and work out a strategy amongst themselves to sort out the problem.”

Following his Gaza trip, Nott spent several weeks in Syria’s Aleppo where conditions have gone from bad to worse over the past three years. He’s been to Syria every year since 2012, and the scale of suffering is “indescribable”. There is a shortage of doctors because they are being killed, hospitals are being bombed, and the number of people still living there is declining because they are being killed with barrel bombs, he explained.

“Gaza was for three weeks, whereas this now is in its fourth year and getting worse and worse. The interesting thing as well was that Gaza was full of media. In Syria no journalists can go in. It’s too dangerous,” he said.

“In 2012, it still wasn’t too bad. In 2013, there were lots of sniper wounds and gunshots. 2014 was far worse - just full of bombs being dropped on civilian buildings, people dying inside the buildings and mostly its children because families have six or seven children and they come in dead and dying. It’s really terrible.”

With the continued bombing of hospitals, the number of casualties is increasing. Among the victims was a close friend of Nott’s, a 22-year-old anesthetist who was killed last week, he said. “It’s very dangerous and it’s deteriorating all the time… No one is reporting on it, or sharing how bad it is. There’s no massive public outcry to what’s going on because people don’t know. It’s just become a terrible state of affairs,” he said.

Nott went to Syria with Syria Relief, a UK-registered charity set up in response to the Syrian crisis. The situation on the ground has become so dangerous that not only journalists have stopped going there, but even relief agencies such as the ICRC, according to Nott. Syrian Relief is also lacking in funds that are constantly needed to provide various materials for surgeries.

“The problem is I don’t see much happening to help Syrian people. They try to get things in, but it’s very difficult. Sometimes we didn’t have any morphine to give to the dying children so they didn’t have any pain relief… (It’s) really heartbreaking,” Nott said.

According to recent UN estimates, 7.2 million people have been displaced within Syria, in addition to 3.3 million Syrian refugees abroad.

Throughout his missions, Nott found himself on the verge of breaking down when dealing with difficult moments.

“Sometimes the effect of seeing, especially children, is very difficult to contend with. You just go and have a private moment with yourself and carry on,” he said. For the next 10 years, Nott said he will focus his efforts on giving others the chance to learn from him and on passing on the lessons he’s accumulated so they can go into conflict zones and do their best to help others.